Natural and Medical Miscarriage Options

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If you have had a miscarriage, your doctor may offer you several choices of miscarriage treatment, each of which entails the eventual removal of the nonviable pregnancy tissue (products of conception) from the uterus. These options include waiting for a natural (or expectant) miscarriage, having a dilation and curettage surgical procedure (D&C), or using medication (or medical management) to induce bleeding.

If your pregnancy loss involves a medical emergency such as a ruptured ectopic pregnancy or a hemorrhage, you will most likely need to have surgery. If you do have a choice in your treatment, each of your options have possible pros and cons depending on your situation, medical history, and personal preferences.

Waiting for Natural Miscarriage

Early in pregnancy, a miscarriage will be very similar to a heavy, crampy menstrual period. It may start with brown spotting that changes to heavier bleeding, sometimes with large blood clots. The bleeding may last up to two weeks, but it should not be heavy for that entire time. If you are soaking through a menstrual pad in under an hour, you should go to the emergency room.

The cramps in a natural miscarriage can range from mild to very strong. Your doctor can recommend painkillers to help manage painful cramps.

Some women prefer nonsurgical miscarriage because they want to avoid checking into the hospital, or they may feel that a D&C procedure is too invasive. Women may also want to avoid the minor risks of complications from a D&C, or they may want to collect the tissue for burial. (However, note that during the earlier stages of pregnancy, the fetal tissue will most likely not be recognizable.) Additionally, rates of complication are similar for all the miscarriage management options.

If a doctor diagnoses a miscarriage before any bleeding has started, it may take days or even weeks for the miscarriage to resolve without intervention. A miscarriage is considered complete when all tissue has been expelled or incomplete when tissue remains in the uterus. Most women, 80% to 90%, will miscarry within two to six weeks without experiencing complications. Still, this can be a prolonged and emotionally difficult waiting process.

Once bleeding has started and a woman chooses a natural miscarriage, they should be sure to follow their practitioner’s recommendations. Most likely, these will include a follow-up appointment to make sure that all the tissue has been removed and their human chorionic gonadotropin hormone (hCG, sometimes referred to as the "pregnancy hormone") levels have returned to zero, at which point the miscarriage is considered complete—and it's a sign it's safe to consider trying to conceive again.

Medication to Induce Miscarriage

If miscarriage bleeding has not started and you prefer to avoid a D&C, your doctor may prescribe a prostaglandin medication, such as misoprostol, to speed up the process. With these medications, a miscarriage will happen in the same manner as with a natural miscarriage. The only difference is that the medication speeds up the process and may result in more intensive cramping or bleeding.

Sometimes, doctors use medication to treat confirmed or probable ectopic pregnancies that are not at immediate risk of rupturing to avoid surgery. For ectopic pregnancy, the standard medical treatment is methotrexate and studies have shown success rates of over 90%.

Although these medications are safe for most women, they do carry risks of hemorrhage and severe cramping. If you choose this option, your doctor will go over any warning signs that require medical attention. You should remain at home or in your doctor's care while taking the medication, as once the drug takes effect, you may be in pain and want to lie down and/or be near a bathroom. Avoid traveling until your doctor evaluates you again to make sure that your miscarriage is complete.

D&C for Pregnancy Loss

Most of the time, surgical management of miscarriage will be done through a D&C. If you are having a D&C, you may need to check into the hospital and have a pre-surgical workup. Some doctors will perform D&Cs in their office, which may feel more comfortable than being in a hospital room.

You will either get local or general anesthesia during the procedure. Your doctor will then dilate your cervix and scrape or vacuum your uterine lining to remove the retained fetal tissue. You will usually be discharged on the same day as the procedure. Your doctor will most likely give you a prescription for pain medication and recommend a follow-up visit a few days to a week or two later.

A D&C may be necessary if the miscarriage poses an immediate threat to your health. This may be the case if you are hemorrhaging or if tissue remains in your uterus after a natural miscarriage. Ultrasound is used to determine if a miscarriage is complete or not. Surgical management may be recommended for some ectopic pregnancies and late pregnancy losses.

A D&C provides the fastest closure, particularly in losses where the bleeding has not yet started. Some women may wish to avoid having a visual image of the remains of the pregnancy. A D&C can make it easier to collect tissue for chromosome analysis to rule out chromosomal abnormalities for those who have experienced recurrent pregnancy loss.

Some doctors use D&C as the default medical treatment for all miscarriages. If you prefer nonsurgical management and your doctor is recommending a D&C without any clear medical need, ask your doctor if other options are appropriate in your case.

A Word From Verywell

Regardless of the management option you choose to resolve your miscarriage (if you have a choice), be sure to seek support and lean on your family and friends in this time of grief. If you are having recurrent miscarriages, discuss possible causes and tests you may want to pursue with your doctor before trying again.

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